Ruminations by a non-academic general surgeon from the heart of the rust belt.

Wednesday, March 25, 2009

Transplant Chains

Interesting story from Medpage Today about an extended donor kidney chain involving now 10 recipients across the USA. What we're talking about is the following: Person A donates a kidney to Person B. Person B has a family member who decides to donate a kidney to unknown Person C. Person C's brother then donates a kidney to unknown Person D. And ad infinitum. The particular streak cited in the article has reached ten. There's even an acronym for the practice (of course there is) of non-simultaneous, extended altruistic donor chains--NEAD.

A cursory reading of this sort of practice is unavoidably heartwarming; the idea of a string of people, unknown to one another, perpetuating the ultimate Gift over the course of many years. Personally, I think it's one of those stories that affirms the inherent potential goodness of human beings. But writing about it, publicizing it has the effect of almost denigrating it to some extent. Like most acts of charity, perhaps it's better left private and unspoken.

And what about hypothetical Person M down the line? What if Person M is a perfect match for a kidney from the brother-in-law of Person L and Person M is overjoyed and filled with thankful relief that finally those long, monotonous, soul-sapping days of dialysis are maybe at an end and then, once the initial excitement abates, Person M's nephrologist slides in the fact that this kidney (Person M's) is a donor kidney from someone in a long NEAD chain and, well, you know, it would be nice if potentially we could continue that chain in the future, once yours is in and functional and you're off dialysis and all.

And Person M sits there numbly contemplating this information, knowing her Mom is dead and her Da drives a bus, smokes like a fiend and has a baseline creatinine of 2.5 and she's estranged from her son in California and her sister is a highly successful real estate agent in New Haven, Connecticut with four kids but she hasn't spoken to her in nearly ten years for reasons too complicated to get into. And there's no one else. No close friends she would ever dare to ask. And she's sitting there in that office trying to reconcile the wonderful news of impending transplantation with the scenario that she will in all likelihood be the one who "breaks the streak" of non-spontaneous altrustic kidney donation.

In baseball, when your team has a rally going and you've strung together a bunch of hits, no one wants to be the last out. Eventually, these NEAD chains will have to end; it's naive to think one would continue interminably. Presumably, recipients won't be required to perpetuate the chain in order to be considered for the kidney (too much of a moral slippery slope). But the longer the chains continue, the more moral pressure is transferred to the next recipient. (Joe DiMaggio certainly felt more pressure to get a hit in game #52 vs. game #9 of the streak). How will they process that pressure? Will it create stress and disharmony amongst their own circle of loved ones, this unspoken obligation to continue a process that very few humans are up to fulfilling? It makes me unconfortable, the publication of something like this. If it happens spontaneously, randomly, then it's a wonderful story. If it continues because of a desire to Continue the Streak, then we've compromised ourselves to some extent.

Congratulations to you and Mrs Buckeye on the new arrival. Now the great adventure begins.... Thank you for your thoughtful blog posts. If you ever retire from surgery, I'm sure you would find a second profession in writing.

I think you bring up an excellent point. Surely, those in charge of organ transplantation should consider this aspect and keep the daisy chain information private until or unless the newest recipient is willing and able to assist in continuing it.

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